摘要
目的分析涂阳肺结核患者并发糖尿病对疗效和治疗转归的影响因素，为制定肺结核并发糖尿病患者的防治策略提供科学依据。方法选择2008-2010年我国上海市、广东省、天津市、河北省、河南省、重庆市、云南省、广西壮族自治区等8个省（市、自治区）结核病定点医疗机构治疗的涂阳肺结核患者共1879例，其中并发糖尿病的肺结核患者183例，无并发症肺结核患者1696例。采用卡方检验比较肺结核并发糖尿病患者和无并发症的肺结核患者在病灶吸收情况、空洞闭合情况、2个月末痰培养结果、耐药情况及治疗转归等方面的差异，检验水准为0．05，同时采用非条件logistic回归分析糖尿病对肺结核治疗效果的影响。结果在1879例涂阳肺结核患者中，9．7％（183／1879）的肺结核患者并发糖尿病。多因素logistic回归分析结果显示，肺结核患者并发糖尿病是2个月末痰培养阳性率（OR=2．348，95％CI=1．619-3．407）、治疗失败（0R=2．668，95％CI=1．366-5．212）和死亡（OR=1．423，95％CI=1．089-4．528）的危险因素。结论肺结核患者并发糖尿病将影响临床疗效和治疗转归，导致2个月末痰培养阳性率、治疗失败及死亡的风险提高，因此在患者就诊时应开展糖尿病筛查，及早发现和治疗糖尿病，提高肺结核患者的治疗效果。
Objective To analyze the effect of anti-tuberculosis （TB） treatment in smear-positive pulmonary tuberculosis （PTB） patients with diabetes mellitus （DM）, to provide reference for development of the prevention and treatment strategy among PTB patients with DM. Methods A prospective study was carried out in eight provinces/regions, including Shanghai, Guangdong, Tianjin, Hebei, He＇nan, Chongqing, Yunnan and Guangxi. One thousand eight hundred and seventy-nine smear-positive PTB patients, who were notified at the TB designated hospitals of the above mentioned 8 provinces/regions from October 2008 to December 2010, were enrolled into this study. Of which, there were 183 PTB patients with DM and 1696 patients without DM. Chi-square test was used to compare the following variables between the PTB patients with DM and without DM： cavity size, lesions absorption, sputum-culture results at the end of 2na month of treatment, drug susceptibility testing （DST） results and treatment outcomes at the end of treatment. A P-value of less than 0.05 was considered to be statistically signifi- cant. Multivariate logistic regression was used to explore whether DM is one of the risk factors for poor treatment outcomes in PTB patients. Results Among 1879 smear-positive PTB patients, 9.7% （183/1879） patients had DM. Multivariate logistic regression analysis showed that DM is significantly associated with culture-positive results at the end of 2nd month of treatment, treatment failure and death in PTB patients, the OR （95%CI） are 2. 348 （1. 619-3. 407）, 2. 668 （1.366-5. 212） and 1. 423 （1. 089-4. 528） respectively. Conclusion DM is one of the risk factors influencing treatment effect and outcome in patients with PTB, may cause the culture-positive rate at the end of 2nd month of treatment, treatment failure rate and death rate of PTB patients increased. Thus, screening for DM in PTB patients should be performed for early detection and treatment of DM and improvement of treatment outcomes of PTB pati
出处
《中国防痨杂志》
CAS
2016年第10期843-849,共7页
Chinese Journal of Antituberculosis
关键词
结核
肺/治疗
糖尿病
危险因素
治疗转归
Tuberculosis
Pulmonary/treatment
Diabetes mellitus
Risk factors
Treatment outcome
